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General NPI Number Information
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NPI Number | 1023197423
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Entity Type | Organization
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Legal Business Name | PEIDMONT NURSING GROUP INC
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Dates
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Enumeration Date | 11/04/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 4642 WEST MAIN ST UNIT # 143
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City | GREENSBORO
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State | NC
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Zip | 27407
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Country | US
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Telephone | 336-416-7057
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Fax | 336-851-2557
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Provider Business Mailing Address
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Address Line | 4642 W MARKET ST UNIT # 143
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City | GREENSBORO
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State | NC
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Zip | 27407-1285
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Country | US
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Telephone | 336-416-7057
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Fax | 336-851-2557
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Authorized Official
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Title or Position | OFFICE MANAGER/CLINICAL SUPERVISOR
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Name | MRS. ERLINA KEARSE LEWIS
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Credential | RN
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Telephone | 336-416-7057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 200693
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License Number State | NC
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